1/7. Traumatic macroglossia: a life-threatening complication.OBJECTIVE: To describe the use of muscle relaxants and a bite raiser to avoid continued tongue trauma. DESIGN: Case report. SETTING: A tertiary general intensive care unit (ICU). INTERVENTIONS: muscle relaxation and bite raiser. MAIN RESULTS: muscle relaxation and a bite raiser were used in a 17-yr-old male with traumatic macroglossia, which allowed for rapid resolution of edema and prevented additional trauma to the tongue. CONCLUSION: Early use of a bite raiser together with muscle relaxants allows for more rapid solution of edema and prevention of additional trauma to the tongue in patients with traumatic macroglossia.- - - - - - - - - - ranking = 1keywords = relaxation (Clic here for more details about this article) |
2/7. Functional airway obstruction mimicking tongue angioedema.BACKGROUND: Functional causes of upper airway obstruction have focused primarily on psychogenic stridor associated with paradoxical vocal cord dysfunction. angioedema can involve upper airway structures and be life-threatening. CASE REPORT: We report a 12-year-old female with upper airway obstruction from posterior tongue swelling which was determined to be a conversion reaction. methods & RESULTS: A lateral neck film revealed severe tongue swelling. Examination revealed a calm, cooperative patient in no distress but exhibiting inspiratory and expiratory stridor. A computed tomography scan revealed soft tissue fullness at the base of the tongue without associated lymphadenopathy. Laboratory evaluation was normal. With anesthetic induction in the operating room, there was complete relaxation of the upper airway with no evidence of tongue swelling, mass, or other abnormality. Following tongue biopsy, she had no reoccurrence of the tongue mass. CONCLUSION: This case represents a childhood conversion reaction of functional airway obstruction where tongue manipulation simulated tongue swelling radiographically consistent with angioedema.- - - - - - - - - - ranking = 0.5keywords = relaxation (Clic here for more details about this article) |
3/7. Achalasia presenting as acute airway obstruction.Achalasia presenting as acute airway obstruction is an uncommon complication. We report the case of an elderly woman with previously undiagnosed achalasia who presented with acute respiratory distress due to megaesophagus. Emergency endotracheal intubation and insertion of a catheter into the esophagus, with continuous aspiration was required. Upon introduction of the esophageal catheter an abruptand audible air decompression occurred, with marked improvement of the clinical picture. Endoscopic injection of botulinum toxin was chosen as the definitive treatment with good clinical result. The pathophysiology of the phenomenon of esophageal blowing in achalasia is unclear, but different hypothetical mechanisms have been suggested. One postulated mechanism is an increase in upper esophageal sphincter (UES) residual pressure or abnormal UES relaxation with swallowing in achalasia patients. We reviewed the UES manometric findings in 50 achalasia patients and compared it with measurement performed in 45 healthy controls. We did not find any abnormalities in UES function in any of our achalasia patients group, or in the case under study. An alternative hypothesis postulates that airway compromise in patients with achalasia results from the loss UES belch reflex (abnormal UES relaxation during esophageal air distension), and in fact, an abnormal UES belch reflex was evidenced in our case.- - - - - - - - - - ranking = 1keywords = relaxation (Clic here for more details about this article) |
4/7. airway management on placental support (AMPS)--the anaesthetic perspective.Neonatal airway obstruction has been reported to have a high mortality. Antenatal diagnosis of this condition is now possible. Anaesthetic and surgical techniques have been developed that allow neonatal airway obstruction to be managed at delivery, while the fetus remains oxygenated via the placental circulation. Three case studies are presented, and the anaesthetic issues for mother and fetus/neonate are discussed with reference to previously published cases of airway management on placental support. In particular, techniques for uterine relaxation and maintenance of placental circulation are explored. The history of these procedures and issues of planning and logistics are also discussed.- - - - - - - - - - ranking = 0.5keywords = relaxation (Clic here for more details about this article) |
5/7. nitroglycerin for relaxation to establish a fetal airway (EXIT procedure).BACKGROUND: The ex utero intrapartum treatment (EXIT) procedure is a technique designed to establish an airway at the time of delivery in fetuses at risk of airway obstruction and requires maintenance of uterine relaxation to continue placental perfusion and prevent placental separation. We describe the use of intravenous nitroglycerin to maintain uterine relaxation during the EXIT procedure. CASE: A 17-year-old primigravida with a fetus known to have an anterior neck mass was admitted for a scheduled operative delivery at 38 weeks of gestation using a modified EXIT procedure. anesthesia was administered with a combined spinal-epidural technique. Intravenous nitroglycerin was administered as a bolus and then as a continuous infusion to maintain uterine relaxation until evaluation of the neonatal airway was completed. CONCLUSION: Intravenous nitroglycerin is an effective agent for maintenance of uterine relaxation and placental perfusion during the EXIT procedure.- - - - - - - - - - ranking = 4keywords = relaxation (Clic here for more details about this article) |
6/7. Nonorganic upper airway obstruction.Two cases of severe dyspnea and stridor with upper airway obstruction of obscure origin are discussed. Complete medical evaluation could identify no organic cause for the symptoms, and functional upper airway obstruction was diagnosed. Treatment with psychotherapy and relaxation techniques was successful. diagnosis can be made with pulmonary function studies. Flow-volume loops may show a lower inspiratory vital capacity than expiratory vital capacity and a discrepancy between inspiratory flow limitation and airway resistance. It is important to establish a functional etiology to prevent unnecessary treatment and provide proper care.- - - - - - - - - - ranking = 0.5keywords = relaxation (Clic here for more details about this article) |
7/7. esophageal achalasia and coexistent upper esophageal sphincter relaxation disorder presenting with airway obstruction.Acute airway obstruction associated with esophageal achalasia is an uncommon but life-threatening complication. The pathophysiology of this phenomenon has not been fully defined. A fully documented case of coexistent esophageal achalasia and upper esophageal sphincter relaxation abnormality presenting with airway obstruction is reported. The patient was initially treated with Heller's myotomy but had a recurrence of respiratory distress. She was successfully treated by cricopharyngeal myotomy. The causes of gas entrapment and respiratory distress are likely to be due to failure of both swallow- and distention-induced upper esophageal sphincter relaxation. Cricopharyngeal myotomy is an effective treatment for this complication, probably by facilitating esophagopharyngeal gas venting.- - - - - - - - - - ranking = 3keywords = relaxation (Clic here for more details about this article) |